Our work in CONNECTIONS

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Our work in CONNECTIONS

Collating good practices on drug treatment

and harm reduction in the criminal justice

system in Europe

– experiences from the CONNECTIONS project

Cinzia Brentari

EMCDDA, Lisbon, 1 March 2011

The

TheConnections project has received funding from the European CommiConnections project has received funding from the European Commission under the Public Health Programme 2003ssion under the Public Health Programme 2003--2008. 2008. However, the sole responsibility for the

However, the sole responsibility for theproject lies with the author and the European Commission is not project lies with the author and the European Commission is not responsible for any use responsible for any use

that may be made of the information contained therein

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Background

Background: :

This project builds on the work and funding that has been invest

This project builds on the work and funding that has been invested ed

over 12 years in networking between European prisons and civil over 12 years in networking between European prisons and civil society organisations on issues of drugs and HIV/AIDS, with fina

society organisations on issues of drugs and HIV/AIDS, with financial ncial

support from the EC and other donors. support from the EC and other donors. Objective

Objective::

to contribute to the development of more effective, inclusive, to contribute to the development of more effective, inclusive, accessible and equivalent HIV/AIDS (and other drug related disea

accessible and equivalent HIV/AIDS (and other drug related diseases) ses)

prevention and drug treatment policies and services for

prevention and drug treatment policies and services for ‘at‘at--riskrisk’’ populations throughout the criminal justice systems of the EU Me

populations throughout the criminal justice systems of the EU Member mber

States and candidates countries. States and candidates countries. Partners

Partners::

University of Kent (

University of Kent (beneficiary) beneficiary) withwith ARAS in RomaniaARAS in Romania, University of , University of Bremen and Frankfurt in Germany, HCLU in

Bremen and Frankfurt in Germany, HCLU in HungaryHungary, , ProbacjaProbacja in in Poland, Rugby House in

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International guidelines and good

practice within CONNECTIONS

Review available research on drug treatment and harm reduction in criminal justice systems:

– Available in CONNECTIONS online digest

Review available international guidelines and recommendations Collect examples of good practice

Create ‘state of the art’ recommendations for working on drugs and related infections.

– Available on the CONNECTIONS website

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Identifying good practice examples (1)

Definition of good practice and scoring:

Level 1 - Promising practice: the approach has sound theoretical basis and has proved its ability to engage the target group and scores 12 or less on the quality grid

Level 2 - Good practice: scores between 13 – 28 points on the quality grid (corresponds to “Promising interventions” on the EDDRA definition)

Level 3 - Top level practice: scores 29 or more points on the quality grid (corresponds to “Top level interventions” in the EDDRA definition)

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Identifying good practice examples (2)

The quality grid is divided into three columns:

– Logic Model (11 criteria – clearly stated objectives on which to

base the follow up - maximum score 13 points)

– Evaluation (7 criteria – process and outcome evaluation to see

whether the activities have helped to achieve the initial objectives -maximum score 18 points)

– Additional Information/Deliveries (5 criteria – coordination with

other services, instruments for evaluation and evaluation manual -maximum score 8 points)

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Identifying good practice examples (3)

Appointment of experts:

– Via focal point contacts and existing network of contacts

– Eleven experts covering twelve countries – four Eastern European

and eight Western European countries

– Staff at Kent University also collected examples from the UK

Evaluation tools:

– Good Practice Form records detailed information about the project

(i.e. who is working with which client group, what is being done, the key features of the project, and how information is collected, analysed and interpreted to assess what outcomes the

intervention has achieved)

– Criteria for Good Practice Form (contains the quality grid against

which the project is scored to arrive at the level of good practice)

– Glossary of Terms

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Identifying good practice examples (4)

List is not exhaustive:

– Focuses on new, lesser known examples

– Intended as exemplars to learn from

– Can be added to through EMCDDA’s Exchange on European Drug

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General findings

‘Top level’ practice is very rare in Europe:

– Significant lack of rigorously evaluated interventions (very few

randomised trials)

Good practice has spread around Europe in the last decade

Good practice is more apparent in prisons and alternative treatments than at either arrest or aftercare stages

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Specific findings

Prison projects – Psycho-social interventions – Needle exchange – Opiate substitution Alternatives to imprisonment From arrest

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Prison projects: Psycho-social interventions

‘Femmeren’ in Denmark (Hjulsøgaardfonden)

– A 24 bed unit in Østjylland high security prison

– Includes detoxification

– Uses motivational enhancement, Gestalt analysis and

cognitive reconstruction

– Achieves reductions in disciplinary incidents and

improvements in physical health

Women’s Substance Dependency Treatment Programme (RAPt)

– A 20 bed unit at HMP Send

– Abstinence based, 12 step programme

– Also uses motivational enhancement and cognitive

behavioural therapy

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Prison projects: Needle exchange

Women’s Prison in Berlin/Lichtenberg

– Established 1998

– All entrants given a harm reduction kit, including a ‘dummy’ syringe – Syringes dispensed through automatic exchange machines

– Syringe sharing among IDUs reduced from 71% to 11%

– No HIV and HBV seroconversions, but four HCV seroconversions occurred

Pereiro de Aguiar Prison, Ourense, Spain

– NSP introduced in 1999

– 93% of staff consider that there has been no increase in conflict in the

prison.

– Syringe sharing amongst IDU inmates reduced from 46%to 7%

Introduction of NSP in Romanian prisons

– Starting in two prisons in 2007, with support from UNODC

– Exchange at a central office by medical staff or peer educators – No increase in drug use

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Prison projects: Opiate substitution

Slovenia

– Methadone from 1995, Buprenorphine from 2005 and

Buprenorphine/Naloxone combination from 2007

– 2008 – OST covers 44% of all recorded drug users in Slovenian prisons.

Integrated Drug Treatment System, England & Wales

– Combines assessment, OST (detoxification, reduction, maintenance,

re-induction) and psychosocial treatment.

Including pilot alcohol interventions in some locations

– Aims to link to services outside prison – 25,076 inductions to treatment in 2008/9 – Being evaluated by NatCen

Realta Prison, Switzerland

– Heroin assisted treatment since 2001, as well as methadone and needle

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Research & development

Research and Intervention Program for Infectious Diseases Risk Reduction among Inmates, France:

– Step 1. Assessing the prevalence of risk behaviours and the availability of

harm reduction measures

– Step 2. Randomised trial of the delivery of a harm reduction package in

prisons:

– HBV vaccination, improved condom access, disinfecting solution,

needle/syringe exchange program, HR counseling, OST, etc. Quality programme for health care services in Spanish prisons:

– Following rapid roll-out of OST in Spanish prisons in 1990s

– Quantitative survey and qualitative consultation with prison and healthcare

staff

– Leading to the development and implementation of agreed clinical

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Follow up

Insertion of the good practices identified into the EDDRA database

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Thanks to

The researchers who coordinated, carried out the work:

Alex Stevens and Karen Milne-Skillman at the University of Kent The national experts:

– Sven Todts, Belgium

– Barbara Janíková, Czech Republic – Niels Løppenthin, Denmark

– Ulla Knuuti, Finland – Laurent Michel, France – Heino Stöver, Germany

Our work in CONNECTIONS